Healthcare Provider Details

I. General information

NPI: 1053384933
Provider Name (Legal Business Name): DAVID O PETERFREUND M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 S FORT HARRISON AVE
CLEARWATER FL
33756-3905
US

IV. Provider business mailing address

1055 S FORT HARRISON AVE
CLEARWATER FL
33756-3905
US

V. Phone/Fax

Practice location:
  • Phone: 727-447-7786
  • Fax: 727-447-5978
Mailing address:
  • Phone: 727-447-7786
  • Fax: 727-447-5978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME42483
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: